Section 404-G:5-c High Risk Pool Administrator.
I. The board shall select a high risk pool administrator through a competitive bidding process to administer the pool. The board shall evaluate bids submitted based on criteria established by the board which shall include:
(a) The high risk pool administrator's proven ability to handle health insurance coverage to individuals;
(b) The efficiency and timeliness of the high risk pool administrator's claim processing procedures;
(c) An estimate of total charges for administering the pool;
(d) The high risk pool administrator's ability to apply effective cost containment programs and procedures and to administer the pool in a cost efficient manner; and
(e) The financial condition and stability of the high risk pool administrator.
II. (a) The high risk pool administrator shall serve for a period of at least 3 years and shall be subject to removal for cause; and
(b) At least one year prior to the expiration of each period of service by a high risk pool administrator, the association shall invite eligible entities, including the current high risk pool administrator to submit bids to serve as the high risk pool administrator. Selection of the high risk pool administrator for the succeeding period shall be made at least 6 months prior to the end of the current period.
III. The high risk pool administrator shall perform such functions relating to the plan as may be as assigned to it, including:
(a) The determination of eligibility;
(b) The payment of claims and the development of procedures to ensure that each claim is promptly paid;
(c) The establishment of a premium billing procedure for collection of premium from persons covered under the pool;
(d) The acceptance of payments of premiums from insureds;
(e) The development of procedures to ensure that medical utilization reviews and grievance determinations are conducted in a fair and timely manner and in accordance with all statutory and regulatory requirements; and
(f) Other necessary functions to assure timely payment of benefits to covered persons under the pool.
IV. The high risk pool administrator shall submit regular reports to the association and the commissioner regarding the operation of the pool. The frequency, content and form of the report shall be specified in the contract between the association and the high risk pool administrator.
V. Following the close of each calendar year, the high risk pool administrator shall determine net written and earned premiums, the expense of administration, and the paid and incurred losses for the year and report this information to the association and the commissioner on a form prescribed by the commissioner.
VI. The high risk pool administrator shall be paid as provided in the contract between the association and the high risk pool administrator.
VII. The association shall submit the contract between itself and the high risk pool administrator to the commissioner for approval.
VIII. The association may select more than one administrator for the high risk pool.
Source. 2001, 295:10, eff. July 1, 2001.